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Journal and News Scan
May 3, 2019
Submitted by: Claire Vernon
Patient Care and General Interest
A roadside thoracotomy was performed in the UK to control severe bleeding for a man who was stabbed, and the procedure was captured on video.
The 30-day public comment period for the US national coverage decision for transcatheter aortic valve replacement has closed, and this brief Cardiovascular Business article summarizes the public response.
Public health officials in the UK call for greater awareness of lung cancer in individuals who have never smoked tobacco.
Several health associations have voiced support for the Tobacco to 21 Act, legislation that was introduced in the US Congress that would raise the minimum federal age to purchase tobacco products.
Drugs and Devices
The US Food and Drug Administration (FDA) has categorized a recall of Miller Balloon and Fogartey Dilation Atrioseptostomy Catheters, issued in March by Edwards Lifesciences, as a Class I recall.
An active fixation lead for quadripolar cardiac resynchronization therapy defibrillators and pacemakers, the Attain Stability Quad left heart lead from Medtronic, is approved by the US FDA.
Research, Trials, and Funding
Lung cancer presents differently in patients with idiopathic pulmonary fibrosis, say researchers in New York City, New York, USA.
Researchers in London, UK, report that the addition of an informational video to a brochure on lung cancer screening improved patients’ understanding and reduced conflicted feelings about whether to undergo the screening.
A study in piglets found that adding hydrogen to ventilation gasses during and after arrested blood flow improved neuroprotection, and the researchers from Boston, Massachusetts, USA, are now aiming to translate these results to people.
May 3, 2019
Submitted by: Aristotle Protopapas
The US FDA approved the Xvivo device for maintaining or resuscitating donor lungs prior to transplant. Interesting very high survival is reported in the control group at one year.
May 2, 2019
Submitted by: Claire Vernon
Thourani and colleagues used data from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry to develop a risk model for in-hospital stroke after transcatheter aortic valve replacement (TAVR), a serious complication. Of the 97,600 TAVR procedures performed between 2014 and 2017 that were included in the analysis, 1,839 patients experienced in-hospital stroke. The authors limited covariate selection to patient demographics and baseline characteristics—with the one exception being access strategy—to increase the usefulness of the model prior to a procedure. Predictors for increased stroke risk included alternative access, prior stroke, procedural acuity, smoking, porcelain aorta, peripheral artery disease, and advanced age.
Additionally, the authors report that patients at 10 of the 521 participating sites were found to have significantly higher odds ratios for stroke than the other sites. They note that the model thus serves as a resource for quality improvement as well as for clinical decision making and patient counseling.
May 2, 2019
Submitted by: Aristotle Protopapas
The overarching, free to read under terms, of the TAVR mini-compendium of this week: the most complex question remains "what is a reasonable expectation of a stakeholder on outcomes of aortic stenosis?"
May 1, 2019
Submitted by: Claire Vernon
Melfi and colleagues present a keynote lecture outlining the evolution of robotic thoracic surgery. The robotic technique in thoracic surgery has progressively become widespread, particularly for the treatment of mediastinal and pulmonary lesions. The authors discuss the development of technology in the robotic system that has been associated with the improvement of intraoperative and postoperative results.
April 30, 2019
Submitted by: Claire Vernon
Aortic endografting leads to aortic stiffening. In this experimental animal study, Yamashita and colleagues evaluated the effect that thoracic endografting had on cardiac afterload, function, and remodeling. The authors report increased aortic input impedance and left ventricular mass after three months, although the effect of experimental descending aorta endografting on left ventricular contractility and efficiency was minimal.
April 29, 2019
Submitted by: Arie Blitz
The authors prospectively analyzed right ventricular (RV) function in 109 patients undergoing a broad range of cardiac surgeries. RV function was assessed at several time points by evaluating TAPSE and 2D longitudinal RV strain to evaluate long axis RV function, and fractional area exchange to evaluate global RV function. After CPB and after chest closure, reduced RV function was demonstrated across all cardiac procedures. Thus, there is a significant failure to protect the RV during surgery.
If one accepts these findings, what modes of myocardial protection should be assessed or re-assessed to protect the RV? Why or why not?
April 28, 2019
Submitted by: Arie Blitz
The authors of this single-center open-label pilot trial evaluated the intermediate-term outcomes of patients undergoing either heart (n=8) or lung (n=36) transplantation from donors that had evidence of active hepatitis C virus (HCV) infection. All patients underwent treatment of HCV antiviral treatment for 4 weeks after transplantation. The primary outcome measured was a composite of a sustained virologic response at 12 weeks after completion of antiviral therapy for HCV infection and graft survival 6 months after transplantation. Of the initial 35 patients who had completed 6 months of follow-up, all patients met the primary outcome. Thus, at intermediate term follow-up, HCV infection was prevented in 100% of patients.
April 28, 2019
Submitted by: Arie Blitz
This single-center study retrospectively analyzed the impact of the implementation of thromboelastography (TEG) on all cardiac procedures performed during 2-year intervals prior to and after TEG implementation. A total of 367 and 310 patients were included in the analysis for the pre-TEG and post-TEG eras, respectively. The authors found that the implementation of TEG was associated with a significant reduction in blood product usage, reoperation, postoperative LOS, and 6-month mortality.
April 28, 2019
Submitted by: Arie Blitz
The authors analyzed the STS database for elective aortic root replacement (with several important exclusions) to derive risk factors for mortality and morbidity. A total of 8,807 patients met inclusion criteria. Significant predictors for mortality that were discovered include atrial fibrillation, body surface area, chronic obstructive pulmonary disease, NYHA IV, diabetes, concomitant coronary artery bypass grafting, concomitant mitral valve surgery, and Bentall operation.